In Our Unit Hands When You Want Them, Staffing When You Need It Janice Tazbir, RN, MS, CS, CCRN, CNE Mark Wicklein, RN, CCRN
A
dequate nursing staff is essential for high-quality patient care. As the Institute of Medicine’s Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes stated: “Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes.”1 Most agree that nurse staffing affects patient safety, but the controversy lies in what research and evidence dictates policies and in how staffing is determined.2 Many hospitals have introduced new models for staffing hospital units in response to shortages of qualified nurses and changes in patient care needs.3 Staffing is especially important in intensive care units (ICUs), where rapid changes in patients’ condition are often life-threatening. Nurse managers use numerous tools to help staff units adequately. Acuity tools are used to decide staffing patterns for oncoming shifts, document patient acuity and historical staffing trends, and determine staff mixing models. Staffing levels are reviewed within time frames, usually by shift, week, month, and year. Historical data are used to project upcoming staffing budgets and staffing needs. Illness severity and patient populations can alter staffing needs greatly and may change often in ICUs. Other tools include patient to nurse ratios, hours of nursing care delivered by the members of the health care team per patient day, and full-time equivalent positions worked in relation to the mean patient census during a particular period.3 Any type of measure can result in overestimates or underestimates of nurse workloads and specific patients’ needs. The qualifications, competencies, credentials, and experience of the staff also affect the number and type of staff required on any particular shift.4 Laws were passed in California for mandatory Authors Janice Tazbir is a professor of nursing at Purdue University Calumet, Hammond, Indiana, and a staff nurse in the surgical intensive care unit at the University of Chicago Medicine, Chicago, Illinois. Mark Wicklein is a patient care support nurse at the University of Chicago Medicine. Corresponding author: Janice Tazbir, RN, MS, CS, CCRN, CNE, College of Nursing, Purdue University, 2200 169th St, Hammond, IN 46324 (e-mail: [email protected]). ©2014 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ccn2014902
www.ccnonline.org
staffing ratios in 2000, and currently a movement is underway to nationalize staffing ratios on the basis of reported successes in California with bill S-739.5 Despite the plethora of tools, staffing remains an inexact science. Current nursing budgets do not allow staffing for potential changes in patients. Once a crisis occurs and additional staff are needed, it may take hours to obtain additional staffing or the staff may have to work in potentially unsafe conditions that may ultimately affect patient safety. Creative staffing innovations are necessary to work within budgetary constraints while maintaining staff satisfaction and patient safety. Staffing innovations (eg, resource nurses, expert nurses, per diems, patient care support nurses, clinical nurses, nurse educators, on-call nurses) have been used to provide additional resources for nurses in many settings. How these positions are defined, staffed, funded, and used differs from institution to institution and even within institutions. Nurse resources may be used as additional staff, clinical nurse experts, bedside nurse educators, or relief nurses. Use of nurse resources has been documented in the adult ICU,6 the pediatric ICU,7 oncology,8,9 and in the operating room.10
CriticalCareNurse
Vol 34, No. 4, AUGUST 2014
89
This article describes how nurse resources were used in a large teaching hospital located in the Midwest. The hospital has approximately 72 adult critical care beds in 6 units. Like many large teaching hospitals, the facility has high patient acuity, and many emergent and unexpected patient situations occur daily. To address this continuous flux in patient conditions and the fiscal inability to staff for “potential patient problems,” resource nurse positions with the title of patient care support nurse (PCSN) were created. The PCSN, as operationalized and defined at this large academic facility, allows “the hands when you want them and the staffing when you need it.” The PCSN position was born from a compromise between a nursing union and management. The original idea was to allow charge nurses in the ICUs to not be assigned patients so that the charge nurses could help other staff members and take over patient assignments in emergent situations. After more thought, it was decided that having charge nurses without patient assignments was not necessary every day. The PCSN position was proposed as a small group of nurses who would be independent of any particular unit and would not have an assigned patient load and thus could assist whenever and wherever needed. The job description, guidelines, workflow, hiring, and orientation process were created by the clinical directors/managers, human resources staff, nurse recruiters, and clinical educators. Currently, the PCSNs for critical care areas report to a patient care manager who is part of the critical care center. The positions have their own separate cost center. If a
90
CriticalCareNurse
PCSN is needed to staff a unit for more than 4 hours in a 12-hour shift, as opposed to helping out in a unit, the cost is assigned to the unit in which the PCSN is staffing. The job description for the PCSN role is not very specific because the role is so broad and varies from day to day and even hour to hour. Generally, these nurses are responsible for coordinating admissions, discharges, and transfers and escorting patients to procedures and tests. PCSNs are also responsible for ensuring that regulatory checks and follow-up corrections are done, including notifying the patient care manager or assistant clinical care manager if problems cannot be resolved at the charge nurse level. The PCSN “floats” through the critical care tower and is immediately available when a code is called in the ICU, a patient unexpectedly experiences an acute hemodynamic decompensation, or patients are admitted who would necessitate a change in staffing. The PCSN is a highly experienced staff nurse who can enter any situation and provide direct care, assist the nurse, or take over a patient assignment when needed. When not actively helping a nurse or providing direct patient care, the PCSN can assist the bedside nurse, the patients, and the units in general. Tasks may include, but are not limited to, making phone calls for the nurse, helping transport patients, staff education, emergent preparation of vasoactive intravenous medications, assistance with various procedures, positioning and providing direct care of patients, and assisting members of the medical health care team while ensuring that proper procedures and policies are
Vol 34, No. 4, AUGUST 2014
followed and enforced. PCSNs also help assess key performance indicators and ensure that initiatives are being followed (eg, prevention of catheter-associated urinary tract infections, admission assessments, and review of flu and pneumonia immunizations). The PCSNs have had a marked effect in these areas, as measurable gains in compliance have occurred.
A Day in the Life of a PCSN After overview sign-out from previous shift, I usually round on the units and touch base with the charge nurses to get a feel for pending admissions and transfers. This is key in cardiovascular and surgical critical care units, as their workload is directly dependent on this information. It also helps me plan the day, as I know in the afternoon that the surgical patients and the hearts will be coming out, a group of patients that can be labor intensive upon admission. I then briefly go room to room and introduce myself to all staff and visitors present, give the staff and charge nurses my pager [number], and get a feel for the day’s activity, road trips for diagnostics and therapeutic adventures. Any very critical patients, or those with highvolume workloads (massive transfusions, complex therapies, unstable vital [signs]) are identified at this time, so they can be revisited on a frequent basis. We also identify educational opportunities,
www.ccnonline.org
for example, a nurse with a pulmonary catheter may want a “refresher” on the routine for a wedge procedure or “shooting an output.” This unscheduled, on-the-spot educational support, “hands on and in real time” has been identified by staff as a persistently valuable action. It is also comforting for a critical care nurse to know that help is readily available, on several levels, from a simple turn to complex troubleshooting. Another element is to oversee patients who have had their primary nurse leave the unit with [the nurse’s] other patient. Providing direct care, in that case, saves a staff nurse covering for the nurse off the unit from being “tripled up.” This also applies to bedside procedures. If a nurse gets overwhelmed or “hit,” I will pick up the second, less critical patient, or depending on the primary nurse’s wishes, I may do procedures with the doctors or pick up the more critical patient. Many things don’t seem like much, but they can really help out nurses. There are lots of little things, those tasks that take only a few minutes that really make the difference. For example, if a nurse is in isolation, for me to take the lab specimens and send them to lab saves that nurse the time it takes to remove personal protective equipment, sanitize, walk to the transport station, and package and send the labs. They then have to walk back, resanitize, put on personal
www.ccnonline.org
protective equipment, and reenter the room. All that is time away from the bedside, away from patient care. Many unscheduled activities evolve during my rounds: a quick boost up in bed, another set of hands to prepare for a road trip, the “Hey, could you please grab me a . . . ?”—all these actions that prevent a nurse from leaving a bedside, because they don’t have to when I do it for them. These secondary gains are hard to concretely quantify, but have a significant global effect on any given nurse and the unit. Another good example is intravenous starts, most days it’s 4 to 6, usually on difficult patients. It’s a time-consuming exercise, especially if you use ultrasound, but if I am doing it, it’s one less task for the primary nurse to be concerned with. Newer physicians readily identify resource nurses. Once they learn that you know where to get things, and how the system works, and can facilitate actions that get things done, they will utilize you often. Teaching physicians “routines of care” is a frequent by-product of these interactions. It sort of shakes out to being available, knowledgeable, and engaged. It’s hard to describe a nebulous function.—Mark Wicklein
Perspective of Nursing Staff As a part-time staff nurse in the critical care unit, I really rely on the PCSN to help out. Even though I have many
years of experience, being part time makes you “rusty” in many procedures because you don’t do them very often. It is great to be able to page someone and get help and the answers without taking the time, which you don’t always have, to look things up. Policies and procedures change on an almost everyday basis, and PCSNs can help because they know them off the top of their head or have the time to check and pull information up for you. The little things . . . sending labs, getting equipment, starting an [intravenous catheter], helping out with a procedure if you are busy in the other patient’s room . . . really add up and make a big overall impact. Off-unit procedures can really take a great deal of time and you can end up really behind with your other patient. Having the PCSN either take the patient for the procedure or to cover your other patient while you are gone can make a huge difference in your day. Before there were PCSNs, I’d dread a “heavy” pair of patients or getting a serious [admission]. It’s not because the other nurses aren’t helpful and great, which they are, it’s just the reality that some days become insane and I may need extra help. —Janice Tazbir
Management Perspective The group of PCS nurses are versatile in the competence
CriticalCareNurse
Vol 34, No. 4, AUGUST 2014
91
of their ICU skill mix. They are flexible when being requested to assist in staffing, which definitely aids the nurses with an increase in patient loads. They are a group of nurses who have established trust, which is very important in critical situations, where they step in to provide much-needed critical care. When asking critical care staff nurses if the PCSN role helped their delivery of care, the overwhelming majority felt [that the PCSNs] enhanced the delivery of care. They also reported that the most common [functions] of the PCSN included [providing care for] unstable patients and the admission/ discharge or transfer of patients.—Jennifer Taylor
Conclusion Use of PCSNs is an effective way to address rapid changes in acuity and to support staff nurses in the ICU while maintaining cost-effective staffing budgets. In one setting, the PCSN role has proven a flexible, cost-effective answer to staffing problems. As health care changes and becomes increasingly complex, innovations are necessary to maintain safe environments. If a teambased approach that involves all aspects of nursing is used, solutions can be created that offer beneficial outcomes for all. CCN Financial Disclosures None reported.
References 1. Wunderlich GS, Sloan F, Davis CK. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate? Washington, DC: National Academy Press; 1996:92. 2. Clarke SP, Donaldson NE. Nurse staffing and patient care quality and safety. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 25. http://www.ncbi.nlm.nih.gov/books /NBK2676/. Accessed May 13, 2014. 3. Butler M, Collins R, Drennan J, et al. Hospital nurse staffing models and patient and staffrelated outcomes. Cochrane Database Syst Rev. 2011;7:CD007019. doi: 10.1002 /14651858.CD007019.pub2. 4. Clarke SP. Research on nurse staffing and its outcomes: the challenges and risks of grasping at shadows. In: Nelson S, Gordon S, eds. The Complexities of Care: Nursing Reconsidered. Ithaca, NY: Cornell University Press; 2006: 161-184. 5. Kasperowicz P. Dem proposes federal regulation of nurse-to-patient ratios in hospitals. The Hill; 2013 April 17. http://thehill.com /blogs/floor-action/senate/294477-dem -proposes-federal-regulation-of-nurse-to -patient-ratios-in-hospitals#ixzz2RaejwZjv. Accessed May 13, 2014. 6. Harrison C, Williams D. What is a clinical resource nurse and how do you develop your own? [poster abstract]. Crit Care Nurse. 2006; 26(2):S18-S19. 7. Boyle L, Osborne D. Clinical resource nurse to the bedside: helping nurses grow clinically and confidently [poster abstract]. Crit Care Nurse. 2008;28(2):e4. 8. Eder S. Roundtable discussion on the evolution of the resource nurse role. J Gynecol Oncol Nurs. 2011;21(3):34-35. 9. Johnston P, Meyers A, Rivera Z, Causton C, Davis, L. Clinical nurse resource: a new role designed to supplement vacant nurse specialists positions. Oncol Nurs Forum. 2006;33(2): 420-421. 10. Welde R. The evening shift: facilitating the operating room as a resource nurse. Stanford Nurs. 2011:2-3.
In Our Unit In Our Unit highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an In Our Unit article, send it to Critical Care Nurse, 101 Columbia, Aliso Viejo, CA 92656; e-mail, [email protected].
Now that you’ve read the article, create or contribute to an online discussion about this topic using eLetters. Just visit www.ccnonline.org and click “Submit a response” in either the full-text or PDF view of the article.
92
CriticalCareNurse
Vol 34, No. 4, AUGUST 2014
www.ccnonline.org
Copyright of Critical Care Nurse is the property of American Association of Critical-Care Nurses and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
A
dequate nursing staff is essential for high-quality patient care. As the Institute of Medicine’s Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes stated: “Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes.”1 Most agree that nurse staffing affects patient safety, but the controversy lies in what research and evidence dictates policies and in how staffing is determined.2 Many hospitals have introduced new models for staffing hospital units in response to shortages of qualified nurses and changes in patient care needs.3 Staffing is especially important in intensive care units (ICUs), where rapid changes in patients’ condition are often life-threatening. Nurse managers use numerous tools to help staff units adequately. Acuity tools are used to decide staffing patterns for oncoming shifts, document patient acuity and historical staffing trends, and determine staff mixing models. Staffing levels are reviewed within time frames, usually by shift, week, month, and year. Historical data are used to project upcoming staffing budgets and staffing needs. Illness severity and patient populations can alter staffing needs greatly and may change often in ICUs. Other tools include patient to nurse ratios, hours of nursing care delivered by the members of the health care team per patient day, and full-time equivalent positions worked in relation to the mean patient census during a particular period.3 Any type of measure can result in overestimates or underestimates of nurse workloads and specific patients’ needs. The qualifications, competencies, credentials, and experience of the staff also affect the number and type of staff required on any particular shift.4 Laws were passed in California for mandatory Authors Janice Tazbir is a professor of nursing at Purdue University Calumet, Hammond, Indiana, and a staff nurse in the surgical intensive care unit at the University of Chicago Medicine, Chicago, Illinois. Mark Wicklein is a patient care support nurse at the University of Chicago Medicine. Corresponding author: Janice Tazbir, RN, MS, CS, CCRN, CNE, College of Nursing, Purdue University, 2200 169th St, Hammond, IN 46324 (e-mail: [email protected]). ©2014 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ccn2014902
www.ccnonline.org
staffing ratios in 2000, and currently a movement is underway to nationalize staffing ratios on the basis of reported successes in California with bill S-739.5 Despite the plethora of tools, staffing remains an inexact science. Current nursing budgets do not allow staffing for potential changes in patients. Once a crisis occurs and additional staff are needed, it may take hours to obtain additional staffing or the staff may have to work in potentially unsafe conditions that may ultimately affect patient safety. Creative staffing innovations are necessary to work within budgetary constraints while maintaining staff satisfaction and patient safety. Staffing innovations (eg, resource nurses, expert nurses, per diems, patient care support nurses, clinical nurses, nurse educators, on-call nurses) have been used to provide additional resources for nurses in many settings. How these positions are defined, staffed, funded, and used differs from institution to institution and even within institutions. Nurse resources may be used as additional staff, clinical nurse experts, bedside nurse educators, or relief nurses. Use of nurse resources has been documented in the adult ICU,6 the pediatric ICU,7 oncology,8,9 and in the operating room.10
CriticalCareNurse
Vol 34, No. 4, AUGUST 2014
89
This article describes how nurse resources were used in a large teaching hospital located in the Midwest. The hospital has approximately 72 adult critical care beds in 6 units. Like many large teaching hospitals, the facility has high patient acuity, and many emergent and unexpected patient situations occur daily. To address this continuous flux in patient conditions and the fiscal inability to staff for “potential patient problems,” resource nurse positions with the title of patient care support nurse (PCSN) were created. The PCSN, as operationalized and defined at this large academic facility, allows “the hands when you want them and the staffing when you need it.” The PCSN position was born from a compromise between a nursing union and management. The original idea was to allow charge nurses in the ICUs to not be assigned patients so that the charge nurses could help other staff members and take over patient assignments in emergent situations. After more thought, it was decided that having charge nurses without patient assignments was not necessary every day. The PCSN position was proposed as a small group of nurses who would be independent of any particular unit and would not have an assigned patient load and thus could assist whenever and wherever needed. The job description, guidelines, workflow, hiring, and orientation process were created by the clinical directors/managers, human resources staff, nurse recruiters, and clinical educators. Currently, the PCSNs for critical care areas report to a patient care manager who is part of the critical care center. The positions have their own separate cost center. If a
90
CriticalCareNurse
PCSN is needed to staff a unit for more than 4 hours in a 12-hour shift, as opposed to helping out in a unit, the cost is assigned to the unit in which the PCSN is staffing. The job description for the PCSN role is not very specific because the role is so broad and varies from day to day and even hour to hour. Generally, these nurses are responsible for coordinating admissions, discharges, and transfers and escorting patients to procedures and tests. PCSNs are also responsible for ensuring that regulatory checks and follow-up corrections are done, including notifying the patient care manager or assistant clinical care manager if problems cannot be resolved at the charge nurse level. The PCSN “floats” through the critical care tower and is immediately available when a code is called in the ICU, a patient unexpectedly experiences an acute hemodynamic decompensation, or patients are admitted who would necessitate a change in staffing. The PCSN is a highly experienced staff nurse who can enter any situation and provide direct care, assist the nurse, or take over a patient assignment when needed. When not actively helping a nurse or providing direct patient care, the PCSN can assist the bedside nurse, the patients, and the units in general. Tasks may include, but are not limited to, making phone calls for the nurse, helping transport patients, staff education, emergent preparation of vasoactive intravenous medications, assistance with various procedures, positioning and providing direct care of patients, and assisting members of the medical health care team while ensuring that proper procedures and policies are
Vol 34, No. 4, AUGUST 2014
followed and enforced. PCSNs also help assess key performance indicators and ensure that initiatives are being followed (eg, prevention of catheter-associated urinary tract infections, admission assessments, and review of flu and pneumonia immunizations). The PCSNs have had a marked effect in these areas, as measurable gains in compliance have occurred.
A Day in the Life of a PCSN After overview sign-out from previous shift, I usually round on the units and touch base with the charge nurses to get a feel for pending admissions and transfers. This is key in cardiovascular and surgical critical care units, as their workload is directly dependent on this information. It also helps me plan the day, as I know in the afternoon that the surgical patients and the hearts will be coming out, a group of patients that can be labor intensive upon admission. I then briefly go room to room and introduce myself to all staff and visitors present, give the staff and charge nurses my pager [number], and get a feel for the day’s activity, road trips for diagnostics and therapeutic adventures. Any very critical patients, or those with highvolume workloads (massive transfusions, complex therapies, unstable vital [signs]) are identified at this time, so they can be revisited on a frequent basis. We also identify educational opportunities,
www.ccnonline.org
for example, a nurse with a pulmonary catheter may want a “refresher” on the routine for a wedge procedure or “shooting an output.” This unscheduled, on-the-spot educational support, “hands on and in real time” has been identified by staff as a persistently valuable action. It is also comforting for a critical care nurse to know that help is readily available, on several levels, from a simple turn to complex troubleshooting. Another element is to oversee patients who have had their primary nurse leave the unit with [the nurse’s] other patient. Providing direct care, in that case, saves a staff nurse covering for the nurse off the unit from being “tripled up.” This also applies to bedside procedures. If a nurse gets overwhelmed or “hit,” I will pick up the second, less critical patient, or depending on the primary nurse’s wishes, I may do procedures with the doctors or pick up the more critical patient. Many things don’t seem like much, but they can really help out nurses. There are lots of little things, those tasks that take only a few minutes that really make the difference. For example, if a nurse is in isolation, for me to take the lab specimens and send them to lab saves that nurse the time it takes to remove personal protective equipment, sanitize, walk to the transport station, and package and send the labs. They then have to walk back, resanitize, put on personal
www.ccnonline.org
protective equipment, and reenter the room. All that is time away from the bedside, away from patient care. Many unscheduled activities evolve during my rounds: a quick boost up in bed, another set of hands to prepare for a road trip, the “Hey, could you please grab me a . . . ?”—all these actions that prevent a nurse from leaving a bedside, because they don’t have to when I do it for them. These secondary gains are hard to concretely quantify, but have a significant global effect on any given nurse and the unit. Another good example is intravenous starts, most days it’s 4 to 6, usually on difficult patients. It’s a time-consuming exercise, especially if you use ultrasound, but if I am doing it, it’s one less task for the primary nurse to be concerned with. Newer physicians readily identify resource nurses. Once they learn that you know where to get things, and how the system works, and can facilitate actions that get things done, they will utilize you often. Teaching physicians “routines of care” is a frequent by-product of these interactions. It sort of shakes out to being available, knowledgeable, and engaged. It’s hard to describe a nebulous function.—Mark Wicklein
Perspective of Nursing Staff As a part-time staff nurse in the critical care unit, I really rely on the PCSN to help out. Even though I have many
years of experience, being part time makes you “rusty” in many procedures because you don’t do them very often. It is great to be able to page someone and get help and the answers without taking the time, which you don’t always have, to look things up. Policies and procedures change on an almost everyday basis, and PCSNs can help because they know them off the top of their head or have the time to check and pull information up for you. The little things . . . sending labs, getting equipment, starting an [intravenous catheter], helping out with a procedure if you are busy in the other patient’s room . . . really add up and make a big overall impact. Off-unit procedures can really take a great deal of time and you can end up really behind with your other patient. Having the PCSN either take the patient for the procedure or to cover your other patient while you are gone can make a huge difference in your day. Before there were PCSNs, I’d dread a “heavy” pair of patients or getting a serious [admission]. It’s not because the other nurses aren’t helpful and great, which they are, it’s just the reality that some days become insane and I may need extra help. —Janice Tazbir
Management Perspective The group of PCS nurses are versatile in the competence
CriticalCareNurse
Vol 34, No. 4, AUGUST 2014
91
of their ICU skill mix. They are flexible when being requested to assist in staffing, which definitely aids the nurses with an increase in patient loads. They are a group of nurses who have established trust, which is very important in critical situations, where they step in to provide much-needed critical care. When asking critical care staff nurses if the PCSN role helped their delivery of care, the overwhelming majority felt [that the PCSNs] enhanced the delivery of care. They also reported that the most common [functions] of the PCSN included [providing care for] unstable patients and the admission/ discharge or transfer of patients.—Jennifer Taylor
Conclusion Use of PCSNs is an effective way to address rapid changes in acuity and to support staff nurses in the ICU while maintaining cost-effective staffing budgets. In one setting, the PCSN role has proven a flexible, cost-effective answer to staffing problems. As health care changes and becomes increasingly complex, innovations are necessary to maintain safe environments. If a teambased approach that involves all aspects of nursing is used, solutions can be created that offer beneficial outcomes for all. CCN Financial Disclosures None reported.
References 1. Wunderlich GS, Sloan F, Davis CK. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate? Washington, DC: National Academy Press; 1996:92. 2. Clarke SP, Donaldson NE. Nurse staffing and patient care quality and safety. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 25. http://www.ncbi.nlm.nih.gov/books /NBK2676/. Accessed May 13, 2014. 3. Butler M, Collins R, Drennan J, et al. Hospital nurse staffing models and patient and staffrelated outcomes. Cochrane Database Syst Rev. 2011;7:CD007019. doi: 10.1002 /14651858.CD007019.pub2. 4. Clarke SP. Research on nurse staffing and its outcomes: the challenges and risks of grasping at shadows. In: Nelson S, Gordon S, eds. The Complexities of Care: Nursing Reconsidered. Ithaca, NY: Cornell University Press; 2006: 161-184. 5. Kasperowicz P. Dem proposes federal regulation of nurse-to-patient ratios in hospitals. The Hill; 2013 April 17. http://thehill.com /blogs/floor-action/senate/294477-dem -proposes-federal-regulation-of-nurse-to -patient-ratios-in-hospitals#ixzz2RaejwZjv. Accessed May 13, 2014. 6. Harrison C, Williams D. What is a clinical resource nurse and how do you develop your own? [poster abstract]. Crit Care Nurse. 2006; 26(2):S18-S19. 7. Boyle L, Osborne D. Clinical resource nurse to the bedside: helping nurses grow clinically and confidently [poster abstract]. Crit Care Nurse. 2008;28(2):e4. 8. Eder S. Roundtable discussion on the evolution of the resource nurse role. J Gynecol Oncol Nurs. 2011;21(3):34-35. 9. Johnston P, Meyers A, Rivera Z, Causton C, Davis, L. Clinical nurse resource: a new role designed to supplement vacant nurse specialists positions. Oncol Nurs Forum. 2006;33(2): 420-421. 10. Welde R. The evening shift: facilitating the operating room as a resource nurse. Stanford Nurs. 2011:2-3.
In Our Unit In Our Unit highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an In Our Unit article, send it to Critical Care Nurse, 101 Columbia, Aliso Viejo, CA 92656; e-mail, [email protected].
Now that you’ve read the article, create or contribute to an online discussion about this topic using eLetters. Just visit www.ccnonline.org and click “Submit a response” in either the full-text or PDF view of the article.
92
CriticalCareNurse
Vol 34, No. 4, AUGUST 2014
www.ccnonline.org
Copyright of Critical Care Nurse is the property of American Association of Critical-Care Nurses and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
